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Permit _t! I/ � 'a CITY OF TIG ® MECHANICAL PERMIT ° : COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00185 TI 13125 SW HaII Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/4/2007 PARCEL: 2S104DC -03500 SITE ADDRESS: 13145 SW CLEARVIEW WAY ZONING: R -4.5 SUBDIVISION: BENCHVIEW ESTATES LOT: 035 JURISDICTION: TIG PROJECT: DUCKETT Project Description: Install a /c. CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: OTHER UNITS: FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Owner: FEES LISA DUCKETT Description Date Amount 13145 SW CLEARVIEW WAY TIGARD, OR 97223 [MECH] Permit Fee 4/4/2007 $72.50 [TAX] 8% State Surchar€ 4/4/2007 $5.80 Total $78.30 Phone: 503 - 590 -8455 Contractor: JACOBS HEATING + NC 4474 SE MILWAUKIE AVE PORTLAND, OR 97202 REQUIRED ITEMS AND REPORTS Contact #: PRI 503- 234 -7331 FAX 503- 808 -9108 Reg #: LIC 1441 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued y: 1 � li Permittee Signat ;, i r ,, w� G ' CaII 503.639.4175 by 7:00 a.m. for inspections th. busi 1 f day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. v Mechanical Permit Application tv .. 41tt ', 4 F� . :v, cili ill t It , i �1 < �l iiv iv. 4, ! xt' -t� t M . r,. =S-. d'r ry.4;SP xa.. =t ..ltl . • a..x'tZlx +f.is City of Tigard , .. , Re ceived r ` � '^ 13123 SW Hall Blvd., Tigard, OR •t . t = • CEIVES Date/By: ©v �� I l i Id7 Or� • `r ^1:a Phone: 503.b39.4171 Fax: 503.598.1966((!!,, Plan Review OuterPermir: �i t - ,4 ri in Line: 503.639.4175 A I' R - 2 7 Date Read /B 's.'�%n": it t Internee wWW.ri turd -Or, oY Y y: RI See Page 2 for 6 S Notified/method; CITY ®f TIGAR® Supplemental tcform rtJuu j ]jiji 1 ,r f F i f. te7'Rrl r a It Ri „, t tEimt ,, , C t v y" T g ., gq.h . =Kt +- L ., , z, 3" : E i , r- r rrn r f p pl i , J7 M Mt+b 1 M bi ?�;.Yltlf,� I 1 �t {.. {+ l� ' . 0 f fi ,�, 'f I - Qfil 3 a ' tal e � ti it't:4 1 > ti li T ;Ij'. �E {I� i CL S � 1y +7'+t„b ' r V{�i�__ 11I �! �• ^.. � � 1 � i� t ,a ,t :�;.a 4 ..,,, � _ " ��t:. y lip .nor,' � f � : "P �.� �' • J1 �' >! t +. t , t U 1 d . i � i � r- t>t y w; :• ❑ New construction L' Addition /alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all 11�� Demolition 1( �1 �l,) V, Other �, } mechanical materi trls, equipment, labor, overhead, and profit. {F,. ttA � ff "� {tt',t 4 e n t ry + 4g x1 4 � p, .�t r4 :. 4,,o ,+ t t + � i ;fa y , lult � I rn l I irglrff:NP :ti:' value: $ V t e ..mtiitn.gii$t8't F31 ' I7� ; x+1 f t- s..,. . , , itv Lu h f it i��k t j o 1 - and 2 family dwelling ❑ Commercial/industrial ❑Accessory buildin ~~ '�- li v ` x r' I 1 '1 4 li i ;� , +. '" , ' ,:t dlLa For special information use checklist. Q Multi family ❑ Master builder 0 Other: Description L Qty. 1 Ea. Total 1a r 9fi 1 v��.� � r � f ynuy� IC ' t�L te t � �, ' ; ! �p �2. �� o,.tat.>; AI + M t 91 t , I1 �'u)I � I � � , . . t'^rWs'r «. t .iyw r 4 1 t1` c 1241 F t C P� $ af E e +Wt �c e:,+ r. J 614 ;Ir] i L,4,1 { BttII COOl,n Job site address: - i 1 j Air conditioning or heat pump 1 A J (requires site plan showlegpltleemcnt) . i 14,00 I Furnace 100,000 BTU (duets/vents) 14.00 Furnace 100.000+ BTU (deers/vents) 17.90 Suite/bldgJapt. no.: Projec name: Gas heal pump 14,00 Cross street/directions to job site: Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hVdroni) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc, 10.00 Subdivision: Lot no -: Flue/vent for any of above 10.00 Other: 10.00 Tax map /parcel no.: Otber fuel appliances � I w+ {r 7 8 lr i '[ ez a� wn a si r' >r+ ,..,., t ve r �.t t r 1 n . P �' `+ �� lr '� I � t`�' �+r r' Haf { : •, 4 ,1k it +F $!} 1,� + r. ' 711 ,B ° a a1-�� Q f I T .;s pel'4, fl � � +Ir, -, ,,� -t ���e' S �? t, 3�i�v' rP�' si3 :7Ce16tFab���1'�*t'!tt�Pi�` ;. r�I�ii'ftls {t ?�aUi� Wn[eC 11e21tC[ 1�.0 Gas fireplace 10.00 NM si Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet Stove 10.00 Wood fireplace/insert 10.00 S .d 11 � wwur < s, +{h� / +p t t r;kk r )1n1 +, i' u h ,i a r�q�n,.�� Chimney /linCr /tlue/Yenl' 10.00 4 Y, ..b .M.:k., f 1 " L '! I � i° lEtt,. 1i1 i ?81 � 11 iii"u ! $0,''k .r r aniif; .1i E' Other: 10.00 � /1 Environmental exhaust and ventilation 1 1 Address: Range hood/other kitchen equipment 10.00 Clothes dryer exhaust 10.00 Single duct exhaust (bathrooms, Phone: ( ) E / M toilet connartmcnts, utility rooms) , 6.80 : ;. 1 v t 11 �t r rr 1�r.R''.1," �y c i to j N I p If i �r.;1• n af +Fa(ryr7 f 'iii . 4to" !� (1 a br t• 1 ,1 t 4 ! 1 1 -3 � I ad r i I I tz `, ,. Vim $ , ,, a 7 (j A W, Attic/otawls ace fans 10, 00 . ;tla �{t i t .:47utr`. l :uu } x u v } : I 0 64:4 , �i,, ':c L� u � {i6t ... I A , 1n. �> rSuwrsra. irSa,f ' i >t ;>< p Business name: Other: 10.00 Fuel piping , Contact name: $5.40 for first four; $1.00 for each additiona Address: Furnace, etc. Gas heat pump City /State/ZIP: WalVsuspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace Ramie I I t a S)R n I � o, , I !' '" '' . 4p, _ - d �:" vq. 4'S + 1 �5,, i ' { n t f y � or t� `f Ql 4�}I 4 ?I#' ref y (�✓t 1'� yl f f 1 It t[!GE'�fir"'�'�c l i +IIRM1 ' 4 . Da.( rt v)A Jt� J jr !S f 'V 4 1 r 1 41 t rr . ;4 ? 8tilk 1. % 1'r+i. - il l 4 0 t pje L clothe Barbecue d eLy .. t. tJ' �N. istN11 .11.:A4/3Jt'�<:.:'.OtL�.5:,4f ! '.�.�14'�L.: I. Clothes d er o i l er: Address: a % , 4 a : �1 t 1 ,=lV,,�y,y 7 x 7e q,,gya,4ff t a. 4t + {I f i �r 1 1 ;a d s - L t f r �+r ''11� ° r , i �. t' Y I . .. f .. Q.1 t, T.7. 11P , l . ..�t�{,.,'60. ,1,rbr ' u { City /State/Z1P: _ Subtotal Minimum permit fee ($72.50) ...wail Phone*" ) ,, '* r F "' / 1 2 ) tii / - - . PO Plan review (25% of permit fee) CCB lie.: I State surcharge (8% of permit fee) :fp TOTAL PERMIT FEE ; I 4 nix p e r mit npplicasion expires if 5 permit iv not ubteioed within 180 Authorized signature: ! days after it has been accepted as complete, Print name: __, name: ,. , • J Date- e 0-1' • Fee methodology set by Tti - County Building Industry Service Gourd l:\Bu;Illiu�lPcru,IlnL�71 C- YenteitApp.doo 04/06/06 440-46t7T(1142/COMIWF�) 1.1.4k q/•) 21 p �1 E0/Z0 39Vd 9NIlV3H SBOObr LS GEI8E0S 9T :ZT LOO? /80/b0 EO/Ee 30Vd fib Dr ? r''SS cT1lCc435 N11t * Al Ili 21 3,. //ett197 Po2T OR . 9' 7Z,o 503 - Z3/ �R .56 3- 234-- tg5Z 9NI213H Sg00Yr (-N; 5 A 6 cg Err rnoaE� Q4 A MAKE. _ anit DI =,DA LSZ6EI8E05 BI:ZI LOH /E9 /b0